MEDICARE: ANGELA PEREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	198059	TX

General Provider Information

NPI Number	:	1790659266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA PEREZ

Provider Business Mailing Address
First Line	:	PO BOX 136607
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76136-0607
Country	:	US
Telephone Number	:	682-224-1441
Fax Number	:	682-224-6374

Provider Business Practice Location Address
First Line	:	3539 NW JIM WRIGHT FWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76106-3201
Country	:	US
Telephone Number	:	682-224-1441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	09/30/2025

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Directions to “ ANGELA PEREZ ” Practice Location

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